How your protected health information may be used and disclosed, and how you can access it.
This notice describes how medical information about you may be used and disclosed and how you can gain access to this information. Please review it carefully.
Jonathan S. Shalom MD Inc., doing business as DrHair90210 (“we,” “us,” or “our”), understands that information about you and your health is personal. We are committed to protecting it. This notice applies to all records of your care generated by our practice and to all members of our workforce.
“Protected health information” (PHI) means information that may identify you and that relates to your past, present, or future physical or mental health, the provision of health care to you, or payment for that care. We are required by law to maintain the privacy of your PHI, provide you this notice of our legal duties and privacy practices, and follow the terms of the notice currently in effect.
We may use and disclose your PHI to provide, coordinate, or manage your care — for example, sharing information with another physician to whom you are referred.
We may use and disclose your PHI to obtain payment for services — for example, submitting information to your insurer to receive reimbursement.
We may use and disclose your PHI for operational purposes such as quality assessment, staff review, licensing, and business management.
The following uses and disclosures may be made without additional authorization, as permitted or required by law:
Other uses and disclosures not described in this notice will be made only with your written authorization. This includes most uses and disclosures of psychotherapy notes (if any), uses for marketing, and any sale of PHI. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.
You may inspect and obtain a copy of your PHI used to make decisions about your care. A reasonable cost-based fee may apply.
You may request that we amend PHI you believe is incorrect or incomplete.
You may request a list of certain disclosures we made of your PHI, going back up to six years.
You may request limits on how we use or disclose your PHI. We are not required to agree, except where required by law.
You may request that we contact you by alternative means or at an alternative location.
You may request a paper copy of this notice at any time, even if you have agreed to receive it electronically.
You have the right to be notified following a breach of unsecured protected health information.
To exercise any of these rights, please submit your request in writing to our Privacy Officer at the contact information below.
We are required by law to maintain the privacy of your PHI, provide this notice of our duties and privacy practices, follow the terms of the notice currently in effect, and notify you in the event of a breach of unsecured PHI. We reserve the right to change this notice and to make the revised notice effective for PHI we already have as well as information we receive in the future. The current notice will be posted at drhair90210.com with its effective date.
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights. All complaints must be submitted in writing. You will not be penalized or retaliated against for filing a complaint.
